ESC 2025 Madrid: Practice-Changing Trials and What They Mean for Cardiology and Electrophysiology

Abstract

The European Society of Cardiology Congress (ESC) 2025 in Madrid delivered a concentrated set of

clinical trials with immediate relevance to practice across cardiology subspecialties. While the congress

spanned topics from hypertension and coronary disease to cardiomyopathies and device therapy, a subset

of trials is especially salient for electrophysiologists: comparative outcomes of pulsed-field vs

radiofrequency ablation in atrial fibrillation (AF); strategies for anticoagulation after successful AF ablation;

and broader therapeutic advances (oral myosin inhibitors for obstructive hypertrophic cardiomyopathy

[HCM]) that shift paradigms in medical management. Here, I summarize these trial findings, discuss their

electrophysiology implications, and propose priorities for future research and guideline consideration.